Breast cancer in the bones: A mastectomy doesn’t end the threat of recurrence

Doctor visit 1

During Dorothy Nelson’s monthly visits to her oncologist, Dr.
Rachel Swart, Nelson expressed a concern for a new pain she
developed in her back. Swart told her the location of her pain
would most likely be another spot for radiation treatment.

Randy Metcalf/The Explorer

Doctor visit 2

Dorothy Nelson, who has Stage 4 breast cancer in the bones, gets
a shot from registered nurse Claudia Sanchez at the Arizona
Oncology at the Northwest Medical Center.

With a smile, Dorothy Nelson waited patiently on Oct. 7 to have
an oncologist confirm what she already knew. She knew that recent
back pain means she will have to go through more radiation
treatments to stabilize the breast cancer running through her
bones.

Dr. Rachel Swart, of the Arizona Oncology offices in the
Northwest Medical Center, said Nelson has a condition known as
metastic breast cancer, or breast cancer in the bone. It has
spread through Nelson’s spine, her skull and most of her body.

Nelson is in Stage 4, and Swart explained during the exam that
cancer could cause bones to fracture or break without impact.

As she examined Nelson, Swart confirmed that while the back
pains may not mean more cancer, it will likely require radiation
treatments to keep the cancer cells neutralized.

As she pressed along Nelson’s body, Swart also found an area of
pain in her abdomen that caused some concern.

After the hour-long appointment, Swart ordered the usual round
of blood tests, medication and shots, but because of Nelson’s
increased pain, she added orders for X-rays and a referral for her
to see a radiologist.

With a positive attitude and a smile, Nelson takes the orders,
endures the treatment and explains that she is getting treatment
for something that she had never heard of until last year.

Nelson, an Oro Valley resident, was originally diagnosed with
cancer nine years ago at age 72. After undergoing a mastectomy,
Nelson said, by removing her breasts, she like many women, assumed
she would be cancer free.

“I didn’t want a lumpectomy, I wanted a mastectomy to just
remove the problem all at once,” she said. “Then, nine years later
I go to the doctor with a pain in my side that doctors thought was
just a muscle pull. Then, the pain switched to the other side, and
before I knew it, they said I had breast cancer in my bones. This
is something I have never even heard of.”

There is always a possibility of recurrence after the first
diagnosis, according to Swart. However, there is not a lot of data
to explain how a form of breast cancer can get into the bone and
spread throughout the body.

One theory is that a breast cancer cell following a mastectomy
can attach to a bone and lay dormant for an unknown amount of time
until something triggers it.

“Unfortunately, it is just something that happens,” Swart said.
“In Dorothy’s case, she did everything right. She got all the right
treatments to prevent it from coming back, but it just
happened.”

One of the problems points to an issue with the health care
system. Swart explained that once a woman has the mastectomy, the
cancer threat is believed to be eliminated; insurance companies
will no longer pay for full-body scans.

Nelson said the breast cancer cells were able to spread
throughout her body for years without her suspecting a thing. Now
that Nelson understands there is no cure, her goal is to educate
other women not to be complacent about preventative care, even
after having a mastectomy.

“I just don’t want people to ignore the signs,” she said. “This
has been really scary for me. My husband and I thought I was going
to die. I was in so much pain. I had the first pains in February of
this year, and by March, I was told I had cancer.”

Nelson has a positive attitude, and believes with proper
treatment the cancer can be neutralized. But, with very little
information about her disease and X-rays showing cancer throughout
her entire body, she said at times she is, “scared because it’s
just everywhere.”

“Women just need to always have in the back for their minds that
the cancer could always come back,” she said. “I feel I’ve lived my
life and done a lot of things. It’s not as much a tragedy for me to
get this diagnosis as it would be for a younger person.”

Nelson said she will continue getting treated, living her life
and being proud of what she has accomplished over the years, no
matter what the future brings.